Healthcare Provider Details

I. General information

NPI: 1457539215
Provider Name (Legal Business Name): GATEWAY BUILDING SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8515 DOUGLAS AVE STE 15
URBANDALE IA
50322-2924
US

IV. Provider business mailing address

8515 DOUGLAS AVE STE 15
URBANDALE IA
50322-2924
US

V. Phone/Fax

Practice location:
  • Phone: 515-249-3083
  • Fax: 515-251-4817
Mailing address:
  • Phone: 515-249-3083
  • Fax: 515-251-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. HOSSEIN ALAVI
Title or Position: OWNER
Credential:
Phone: 515-249-3083